CCM Case Management RN

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About The Role

Telephonic case management role in which you will educate members on improving health outcomes, assist with transitions from care settings, participate in process improvement and other pilot programs as they arise, and work with the Clinical Concierge Specialist and other Oscar teams to ensure exceptional care for our members. You will report into the Manager, Clinical Programs.

Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia and Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. Internal applicants living outside of the listed location(s) will be considered for this role provided they meet all job requirements and internal transfer eligibility criteria.

Pay

The base pay for this role is: $32.60 - $42.79 per hour. You are also eligible for employee benefits, including 15 days of paid vacation per year, medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Responsibilities

• Assist in the coordination of care across a variety of settings (ER, inpatient, post acute, outpatient, home care) while maintaining strict confidentiality and the highest level of professionalism.
• Actively reach out to members undergoing difficult health challenges and help guide them through the healthcare system to improve their overall experience.
• Complete a comprehensive biopsychosocial needs assessment to help identify member needs.
• Develop an outcome-based plan of care, based on the member’s input and assessed clinical and social needs with anticipated targeted dates for accomplishment.
• Proactively reach out to hospital case managers to assist with safe discharge planning to appropriate level of care or home.
• Seek guidance from medical directors to advocate for members to get the appropriate care they need. Act as a member advocate and assist with problem solving, as well as addressing any barriers to care or compliance with the care plan.
• Educate other teams on the CCM program and collaborate to identify high risk members who would be appropriate.
• Work with non-clinical teammates in assisting members to navigate the healthcare system, including coaching non-clinicians on how they can add value to all member interactions.
• Communicate with members via phone, secure messaging, and in person to provide education on health conditions, new medications, and procedures.
• Participate in surveys, studies, and special projects as assigned.

Requirements

• 2+ years of clinical experience.
• Active, unrestricted Nursing license (RN) in your state of hire and ability to obtain additional licensure as needed.

Bonus Points

• Working knowledge of Milliman Care Guidelines
• Case Management experience
• CCM certification
• BSN
• Previous work from home and proven comfort with accessing systems remotely
• Bilingual in Spanish or Creole